Matching healthcare claim data for identifying and quantifying relationships between healthcare entities

ABSTRACT

Matching carrier claims to facilities based on billed claims data in a healthcare system. A method includes identifying a carrier claim processed by a practitioner and matching the carrier claim to a facility to generate a matched claim based on a claims factor. The method is such that the claims factor comprises one or more of a patient identifier, a date of service for a procedure billed on the carrier claim, a practitioner identifier associated with the practitioner, a facility identifier for an inpatient facility associated with the carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility, a most common facility associated with the practitioner.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional PatentApplication No. 62/939,349, filed Nov. 22, 2019, titled “IDENTIFICATIONOF EMPLOYMENT RELATIONSHIPS BETWEEN HEALTHCARE PRACTITIONERS ANDHEALTHCARE FACILITIES,” which is incorporated herein by reference in itsentirety, including but not limited to those portions that specificallyappear hereinafter, the incorporation by reference being made with thefollowing exception: In the event that any portion of theabove-referenced provisional application is inconsistent with thisapplication, this application supersedes the above-referencedprovisional application.

TECHNICAL FIELD

The disclosure relates generally to the analysis of healthcare systemsand particularly to merging healthcare data.

BACKGROUND

The healthcare industry is extraordinarily complex. Specifically, in theUnited States, relationships between healthcare practitioners, clinics,facilities, groups, and systems are complex and interwoven such that itcan be challenging to identify relationships between different entities.One practitioner may see patients that are part of different systems,health insurance networks, or groups. Further, the practitioner may beassociated with more than one facility or clinic. The interwovenrelationships between healthcare entities makes it challenging todetermine if a certain practitioner is associated with or employed by acertain facility, clinic, group, or system. Additionally, otherrelationships between practitioners, facilities, clinics, groups, andsystems throughout the healthcare industry are difficult to identify andquantify.

In some instances, it is necessary or beneficial to understand therelationships between healthcare entities. For example, a healthinsurance provider seeking to create an in-network selection ofproviders may need to know which practitioners are associated with whichfacilities, clinics, groups, or systems. Further for example, amanufacturer or seller of medical devices or pharmaceuticals may benefitfrom understanding the business relationships between practitioners,facilities, clinics, groups, and systems. In some instances, forexample, the manufacturer or seller may sell a medical device orpharmaceutical to a single group, and this would in turn lead todistribution of that medical device or pharmaceutical to hundreds ofpractitioners associated with the group. These relationships betweenhealthcare entities are nearly impossible to identify or quantify.

In light of the foregoing, disclosed herein are systems, methods, anddevices for identifying relationships between healthcare entities.

BRIEF DESCRIPTION OF THE DRAWINGS

Non-limiting and non-exhaustive implementations of the presentdisclosure are described with reference to the following figures,wherein like reference numerals refer to like parts throughout thevarious views unless otherwise specified. Advantages of the presentdisclosure will become better understood with regard to the followingdescription and accompanying drawings where:

FIG. 1 is a schematic diagram of a framework outlining affiliationsbetween healthcare entities;

FIG. 2 is a schematic diagram of a system for data communication betweena data merging component and internal and external data sources;

FIG. 3 is a schematic diagram of a system for performing electronic datasecurity measures on data received from an external data source;

FIG. 4 is a schematic diagram of a data flow to a data merging componentconfigured for merging carrier claims data and facility claims data;

FIG. 5 is a diagram of a file organization schematic for ProviderEnrollment, Chain and Ownership System (PECOS) enrollment data;

FIG. 6 is a schematic flow chart diagram of a plurality of matchingiterations to be completed in succession for matching carrier claims toone or more facilities, wherein each of the matching iterationscomprises one or more claims factors for matching the carrier claims tothe one or more facilities;

FIG. 7 is a data flow chart for identifying and quantifying apractitioner-clinic billing relationship;

FIG. 8 is a data flow chart for identifying and quantifying apractitioner-clinic enrollment relationship;

FIG. 9 is a data flow chart for identifying and quantifying clinic-groupownership relationship;

FIG. 10 is a data flow chart for identifying and quantifying apractitioner-facility procedure relationship;

FIG. 11 is a data flow chart for identifying and quantifying apractitioner-facility employment relationship;

FIG. 12 is a data flow chart for identifying and quantifying afacility-system ownership relationship;

FIG. 13 is a data flow chart for identifying and quantifying afacility-clinic location-based relationship;

FIG. 14 is a schematic flow chart diagram of a method for matchinghealthcare claims data; and

FIG. 15 is a schematic diagram illustrating components of an examplecomputing device.

DETAILED DESCRIPTION

Disclosed herein are systems, methods, and devices for merginghealthcare claim data for identifying and quantifying relationshipsbetween healthcare entities. In an embodiment, carrier claims arematched with facilities and/or facility claims, and unmatched claims areassigned to certain providers. The matched claim data can be leveragedto identify various relationships between healthcare entities.

Current understanding of the healthcare industry in the United States isextremely fragmented. In some instances, it is difficult or impossibleto identify systems of care including financial, employment, andenrollment relationships between healthcare entities. The healthcareindustry uses multiple data sources for storing billing, procedure, andfacility records. There is no one data source that is ideal or reliablefor identifying the numerous relationships between healthcare entities.Because healthcare data is fragmented, it can be beneficial to matchdifferent types of healthcare data. The matched data can be assessed toidentify and quantify relationships between different entities.

Embodiments of the disclosure leverage multiple data sources to describerelationships precisely and completely between healthcare entities.Relationships between practitioners and other healthcare entities cannotbe viewed as binary. There are multiple types of affiliations betweenhealthcare entities, and each affiliation may be characterized in termsof its strength. An affiliation reported as merely binary (i.e. yes/no,exists/does not exist, and so forth) masks important information.

Embodiments of the disclosure begin at the level of individualpractitioner billing and procedure codes and build from there toidentify and quantify relationships between other healthcare entities.By tracking the relationships of individual practitioners to higherlevel entities, the connections between practitioners and multiple otherentities can be identified. This is an improved and more streamlinedmethod when compared with viewing all organizations as discrete,mutually exclusive sets of practitioners.

Embodiments of the disclosure interpret affiliation metrics based on anindividualized perspective. For example, a physician's affiliation witha hospital has two perspectives: the physician's perspective and thehospital's perspective. The physician may view the hospital as anecessary portion of the practice that enables the physician to performcertain procedures. The hospital may view the physician as one of many,and the physician's procedures performed at the hospital may represent avery small portion of all procedures performed at the hospital.Understanding affiliations from both perspectives is more informativethan viewing the affiliations from only one perspective.

Embodiments of the disclosure describe affiliations in terms ofreal-world activities that link practitioners to other healthcareentities. This can be performed by assessing disparate data sources interms of real-world actions or relationships. Some actions, such asreferrals or billing of office claims, may come naturally from a singledata source. Other actions, such as geographic practice locations andclinic ownership, require synthesis of multiple data sources. The goalis not merely to represent the data sources, but to leverage the datasources to represent the real world. This results in new metrics andrelationships that did not exist before. In embodiments of thedisclosure, raw data is manipulated to identify real-world relationshipsthat could not previously be identified or quantified.

Embodiments of the disclosure state affiliations between healthcareentities through action. For example, rather than querying practitionersand other healthcare entities about how they believe they areaffiliated, it is more accurate to assess actual behaviors thatilluminate real-world relationships free from spin, bias, ignorance,misunderstanding, or self-reported outcomes.

Before the structures, systems, and methods for merging healthcare dataare disclosed and described, it is to be understood that this disclosureis not limited to the particular structures, configurations, processsteps, and materials disclosed herein as such structures,configurations, process steps, and materials may vary somewhat. It isalso to be understood that the terminology employed herein is used forthe purpose of describing particular embodiments only and is notintended to be limiting since the scope of the disclosure will belimited only by the appended claims and equivalents thereof.

In describing and claiming the subject matter of the disclosure, thefollowing terminology will be used in accordance with the definitionsset out below.

It must be noted that, as used in this specification and the appendedclaims, the singular forms “a,” “an,” and “the” include plural referentsunless the context clearly dictates otherwise.

As used herein, the terms “comprising,” “including,” “containing,”“characterized by,” and grammatical equivalents thereof are inclusive oropen-ended terms that do not exclude additional, unrecited elements ormethod steps.

As used herein, the phrase “consisting of” and grammatical equivalentsthereof exclude any element or step not specified in the claim.

As used herein, the phrase “consisting essentially of” and grammaticalequivalents thereof limit the scope of a claim to the specifiedmaterials or steps and those that do not materially affect the basic andnovel characteristic or characteristics of the claimed disclosure.

Reference will now be made in detail to the exemplary embodiments,examples of which are illustrated in the accompanying drawings. Whereverpossible, the same reference numbers are used throughout the drawings torefer to the same or like parts. It is further noted that elementsdisclosed with respect to embodiments are not restricted to only thoseembodiments in which they are described. For example, an elementdescribed in reference to one embodiment or figure, may be alternativelyincluded in another embodiment or figure regardless of whether or notthose elements are shown or described in another embodiment or figure.In other words, elements in the figures may be interchangeable betweenvarious embodiments disclosed herein, whether shown or not.

Referring now to the figures, FIG. 1 illustrates a framework 100 thatoutlines affiliations between healthcare entities. The framework 100 isbuilt from the ground up and begins with the practitioner 102. Thepractitioner may be affiliated with facilities 110 and/or clinics 106. Afacility 110 may be affiliated with a system 118. A clinic 106 may beaffiliated with a group 114. There may be affiliations between systems118 and groups 114 and between facilities 110 and clinics 106.

In an embodiment of the framework 100, a distinction is drawn betweensystems 118 that may own facilities 150, and groups 114 that may ownclinics 106. This distinction is made for illustrative purposes and toincrease the accuracy of conclusions drawn from assessing healthcareaffiliations. In some instances, this distinction does not exist in thereal world, and systems 118 and groups 114 functionally operate as thesame entities. This serves as justification for the ground-up approachthat permits individual practitioner behaviors to be leveraged todescribe the relationships of higher-level entities with one another.

The practitioner 102 is a healthcare practitioner such as a physician(Doctor of Medicine), physician assistant, nurse practitioner,podiatrist, dentist, chiropractor, psychologist, optometrist, nursemidwife, clinical social worker, and so forth. The practitioner 102 maybe a single person licensed to provide healthcare advice or guidance,perform procedures, prescribe medications, and so forth. Thepractitioner 102 may be a solo practitioner, may be associated with agroup of other practitioners 102 in a clinic 106 or other group setting,may be employed by a facility 110 such as a hospital, may be employed asan in-house practitioner, and so forth. In some instances, it can bebeneficial to identify and quantify the practitioner's 102 relationshipswith other entities such as clinic 106, facilities 150, groups 114, andsystems 118.

The practitioner 102 may be associated with a practitioner ID 104. Insome embodiments, the practitioner ID is an individual NPI (NationalProvider Identifier). In the United States, an individual NationalProvider Identifier (NPI) is a Health Insurance Portability andAccountability Act (HIPAA) administrative standard. An individual NPI isa unique identification number for covered healthcare providers. In theUnited States, covered healthcare providers, health plans, andhealthcare clearinghouses are directed to use NPIs in administrative andfinancial transactions. It should be appreciated that the practitioner104 may be associated with any unique identifier and does not need to beassociated with a National Provider Identifier. The use of some otherunique identifier does not depart from the scope of the disclosure. Thepractitioner ID 104 is a unique code associated with the practitioner102. It should be appreciated that the practitioner ID 104 is any uniquecode associated with the practitioner 102 and can include other codeswithout departing from the scope of the disclosure.

The clinic 106 is a group of practitioners, a single practitioner, orsome other entity that is primarily focused on the care of outpatients.The clinic 106 may be an outpatient clinic, an ambulatory care clinic, aphysical therapy clinic, a specialist clinic, an urgent care clinic, anemployer-funded in-house healthcare clinic, and so forth. The clinic 106may be a group of practitioners that practice together at the samephysical location or at different physical locations. The clinic 106 mayinclude one or more practitioners 102 that practice telehealth care overthe phone, over video communications, or by some other form ofcommunication. The clinic 106 may be privately operated or publiclymanaged and funded. The clinic 106 may be suited for covering primaryhealthcare needs or specialized outpatient healthcare needs forpopulations of communities, in contrast with larger hospitals that offerspecialized treatments and admit inpatients for overnight stays. Theclinic 106 is not limited to only providing outpatient care.

The clinic 106 may be associated with a clinic ID 108. In someembodiments, the clinic ID 108 is an organization NPI (National ProviderIdentifier). In the United States, an organization National ProviderIdentifier (NPI) is a Health Insurance Portability and AccountabilityAct (HIPAA) administrative standard. An organization NPI is a uniqueidentification number for covered healthcare clinics. The clinic ID 108is a unique code associated with the clinic 106. If the clinic 106 hasmultiple geographic locations, then each of the multiple geographiclocations for the clinic 106 may have a unique clinic ID 108. In someinstances, two or more locations for the same clinic 106 share a clinicID 108. It should be appreciated that the clinic 106 may be associatedwith any unique identifier and does not need to be associated with anorganization NPI. The use of some other unique identifier does notdepart from the scope of the disclosure.

The facility 110 is a physical or virtual healthcare location where anindividual can receive care from a practitioner 102. The facility 110may include hospitals, ambulatory surgical centers, birth centers, bloodbanks, dialysis centers, hospice centers, imaging and radiology centers,mental health and addiction treatment centers, nursing homes, orthopedicand other rehabilitation centers, telehealth systems, and so forth. Insome implementations, it is not necessary to provide a formal definitionfor a facility 110 versus a clinic 106, and this distinction can bedrawn based on the factual circumstances of various healthcare entities.

In an example embodiment, the facility 110 is linked to a facility ID112. In some embodiments, the facility ID 112 is a Centers for Medicareand Medicaid Services (CMS) Certification Number, which is referred toas a CCN. In the United States, the CCN is the facility's 110 uniqueidentification code that is linked to the facility's 110 provideragreement for Medicare billing. In some instances, the CCN is referredto as the facility's 110 “provider number.” The facility ID 112 is usedfor submitting and reviewing the facility's 110 cost reports. It shouldbe appreciated that the facility 110 may be associated with any uniqueidentifier and does not need to be associated with a CCN. The use ofsome other unique identifier does not depart from the scope of thisdisclosure.

The group 114 is a healthcare entity that owns one or more clinics 106.The group 114 may alternatively be referred to as a “provider group.” Insome instances, there is no real-world distinction between groups 114and systems 118, and this distinction is made in the systems, methods,and devices disclosed herein for the purpose of improving analytics onvarious healthcare entities. In some instances, a single healthcareentity may be referred to as a group 114 and as a system 118 forpurposes of improving the analytics described herein.

The group 114 may be associated with a group ID 116. In someembodiments, the group ID 116 is a PAC ID (Practice Access Code ID)assigned by PECOS (Provider Enrollment, Chain and Ownership System). ThePECOS is a system used in the United States and enables practitionersand other healthcare facilities to register with the Centers forMedicare and Medicare Services. PECOS is the Provider, Enrollment,Chain, and Ownership System. The system 118 may further be associatedwith the group ID 116. In some cases, a group 114 and a system 118 arethe same entity and are associated with the same group ID 116. In somecases, a group 114 and a system 118 are separate entities to the degreethat the group 114 is associated with its own group ID 116 and thesystem 118 is associated with its own system ID 120.

The system 118 is a healthcare entity that owns one or more facilities110. In some instances, there is no real-world distinction betweengroups 114 and systems 118, and this distinction is made in the systems,methods, and devices disclosed herein for the purpose of improvinganalytics on various healthcare entities. In some instances, a singlehealthcare entity may be referred to as a group 114 and as a system 118for purposes of improving the analytics described herein.

There are numerous metrics that can be calculated based on therelationships between practitioners 102, clinics 106, facilities 110,groups 114, and systems 118. In some cases, the metrics are determinedbased on claims billed by any of the entities described in FIG. 1. Somebasic affiliation metrics that can be calculated include practitionerbilling metrics, clinic billing metrics, practitioner enrollmentmetrics, clinic enrollment metrics, practitioner-group billing metrics,group billing metrics, practitioner-facility procedure volume metrics,facility procedure volume metrics, practitioner-facility employmentmetrics, facility-clinic distance metrics, and others. The practitionerbilling metric is the proportion of a practitioner's total office claimsbilled to a certain clinic associated with a specific clinic ID 108. Theclinic billing metric is the proportion of total office claims billedunder a clinic performed by a given practitioner. The practitionerenrollment metric is the clinics at which a practitioner is enrolled inthe PECOS. The clinic enrollment is the practitioner(s) enrolled in thePECOS under a clinic. The practitioner-group billing is the proportionof the practitioner's office claims billed under any of the group'sclinics. The group billing is the proportion of all office claims billedunder any of the group's clinics that were performed by a specificpractitioner. The practitioner-facility procedure volume is theproportion of a practitioner's total procedure claims performed at eachfacility. The facility-procedure volume is the proportion of theprocedures performed at the facility performed by each practitioner. Thepractitioner-facility employment is the level of confidence that thepractitioner is employed by a given facility. The facility or clinicdistance is the distance between a clinic and a facility in miles orsome other distance measurement.

FIG. 2 is a schematic diagram of a system 200 for data communicationbetween a data merging component 202 and internal and external datasources. The data merging component 202 manipulates and matches datafrom multiple sources to generate matched data. The matched data canthen be analyzed to identify and quantify relationships betweendifferent healthcare entities. The data merging component 202 performsthese calculations based on real-world claim data and/or enrollment datathat can be stored in a combination of internal and external datasources. The data merging component 202 may communicate with one or moreof an internal data source 204 and an external data source 206. Theinternal data source 204 may be a database, data store, or other memorydevice that is “internal” to the data merging component 202 or ismanaged by the same entity as the data merging component 202. Theexternal data source 206 may be a database, data store, or other memorydevice that is “external” to the data merging component 202 or ismanaged by some other entity such that the data merging component 202must access that data by way of an Application Program Interface (API),by receiving a file, by accessing an external server, and so forth.

In an embodiment, the data merging component 202 communicates directlywith an external data source 206 that is managed or owned by athird-party entity. In an embodiment, the external data source 206 isowned and managed by the Medicare system operated by the United Statesgovernment, or by some other entity that has been tasked with managingdata for the Medicare system. In an embodiment, the external data source206 is a relational database, and the data merging component 202communicates with the relational database by way of an ApplicationProgram Interface (API). In an embodiment, the external data source 206is an encrypted hard-drive that has been shared with the data mergingcomponent 202. In an embodiment, the external data source 206 is avirtual data center, and the data merging component 202 accesses thedata on a virtual server after signing in or undergoing some otherauthentication step.

In an embodiment, the data merging component 202 communicates with aninternal data source 204 that is not managed by some other third-partyentity. The internal data source 204 may include a file that has beendownloaded or otherwise received from some third-party entity, such asthe Medicare system. After the file has been downloaded, the file can bemanaged and manipulated by the data merging component 202. The internaldata source 204 may include an encrypted hard-drive or downloadedencrypted file that is provided by a third-party, such as the Medicaresystem.

The data merging component 202 may receive and translate informationfrom multiple different sources. In an example implementation, the datamerging component 202 receives enrollment information from a centraldata warehouse that may be operated internally or by a third-party. Thedata merging component 202 further receives claims data from a differentsource, for example via a secure connection to a virtual data store byway of an API, by accessing an encrypted hard drive, or accessing anencrypted file that has been downloaded by way of a network connection.

In an embodiment, the data stored in the internal data source 204 hasbeen “cleaned” or pared down to only include necessary or criticalinformation. This can be beneficial to ensure the totality of the datais a usable size that can be efficiently queried, analyzed, andmanipulated. For example, the raw data retrieved from the external datasource 206 may include numerous data fields that are not necessary foridentifying a certain relationship between healthcare entities. Theunnecessary data may be eliminated, and only the necessary data may bestored on the internal data source 204. In an embodiment, the raw datais cleaned and stored in a relational database.

In an embodiment, the data merging component 202 analyzes informationstored in the internal data source 204 and/or the external data source206 by identifying relationships between individual practitioners 102and their associated clinics 106 and groups 114. In an example use-case,the data merging component 202 identifies that Doctor A is performingwork for Clinic B. The data merging component 202 then identifies all ofthe practitioners that associate with Clinic B and assesses the carrierclaims billed by those practitioners. The data merging component 202aggregates the claim information for all practitioners in Clinic B andcombines the information in an effort to answer specific questions, suchas whether a certain practitioner is employed by a facility.

The data merging component 202, or some other module or component incommunication with the data merging component 202, may createintermediary files or tables within a relational database. Theintermediary files or tables may include certain information columnsthat are pertinent to answer a specific question, such as identifying orquantifying a relationship between two or more healthcare entities. Thiscan be beneficial to ensure that each intermediary file or table is nobigger than it needs to be to include all necessary information foranswering the specific question. This decreases the amount of discstorage and/or Random Access Memory (RAM) needed to analyze theinformation and calculate the answer to the specific question.

FIG. 3 is a schematic diagram of a system 300 for performing electronicdata security measures on data received from the external data source206. The data merging component 202 receives claims data (see 302) froman external data source 206. The claims data may include carrier claims,facility claims, and other claims generated or processed by private orpublic healthcare entities. Claims data includes sensitive informationsuch as protected personal information (PPI) and personal identifiableinformation (PII), and therefore, the claims data must be encrypted orotherwise secured.

In an embodiment, the data merging component 202 receives claims data bysecurely communicating with a virtual data center (see 310). The virtualdata center may be provided by a private or public healthcare entity. Inan embodiment, an account is created for a user associated with the datamerging component 202, and the user can sign into the virtual datacenter with the account. The user can then access the data stored in thevirtual data center 310 by way of the account. The data may be encryptedor non-encrypted based on the security measures of the virtual datacenter. In an embodiment, the data is non-encrypted when viewed by wayof a network connection, and the data is encrypted if downloaded foroffline use and manipulation. If the data is downloaded in an encryptedform, then the data must be de-encrypted prior to analysis andmanipulation.

In an embodiment, the data merging component 202 receives claims data byway of an encrypted hard-drive. The encrypted hard-drive may be providedby the source of the data, such as private or public healthcare entity.In an embodiment, the data merging component 202 receives claims data byway of an encrypted file that has been downloaded by way of a networkconnection. The data merging component 202 undergoes an electronic datasecurity measure 308 by de-encrypting the claims data (see 312).

FIG. 4 is a schematic diagram of a data flow 400 for merging carrierclaims 402 and facility claims 404. The data merging component 202receives claim information and matches carrier claims 402 to facilityclaims 404 to generate matched claims.

A carrier claim 402 is a non-institutional medical billing claimsubmitted by or on behalf of a practitioner 102. The carrier claim 402may be billed for outpatient or inpatient services. The carrier claims402 used by the data merging component 202 may include carrier claims402 submitted through the Medicare system implemented in the UnitedStates and may additionally include carrier claims for private entitiessuch as private health insurance agencies. If the carrier claims 402include Medicare claims, then the carrier claim may be submitted on thehealth insurance claim form CMS-1500 used by the United States Medicaresystem.

Carrier claims 402 include information about a service provided by apractitioner 102 in an outpatient or inpatient setting. In someinstances, only a portion of the information included in the carrierclaim 402 is relevant to the analysis of whether a relationship existsbetween two or more healthcare entities. Carrier claims 402 may includea patient identifier (ID) 406, which may include a numerical oralphanumerical code assigned to the patient, and may further include thepatient's name, address, or other contact information. Carrier claims402 further include a practitioner ID 104 which may specifically includean individual NPI. The carrier claim 402 may include a clinic ID 108, orsome other information identifying the name, location, or contactinformation of the clinic under which the service was performed. Thecarrier claim 402 includes an indication of the date of service 408 whenthe service was performed or on what date the service began if theservice extended over multiple days. The carrier claim 402 includes anindication of the place of service 410, and this may be a numerical oralphanumerical code identifying a type of facility, and may also includea name, address, or other contact information for the facility. Thecarrier claim 402 includes one or more billing codes 412 identifying theservices or procedures that were performed by the practitioner 102. Thebilling code 412 may include a Healthcare Common Procedure Coding System(HCPCS) code. The carrier claim 402 may further include an indication ofthe days or units 414 indicating a duration of time the procedureoccurred.

The facility claims 404 may include similar information. If the facilityclaims 404 include Medicare claims, then the facility claims may besubmitted on the health insurance claim form UB-40 used by the UnitedStates Medicare system. The facility claims 404 may include, forexample, the patient ID 406, practitioner ID 104, facility ID 112, dateof service 408, place of service 410, billing code 412, days or units414, and an indication of the type of visit 416. The facility ID 112identifies the facility at which the procedure was performed, and maytake the form of an NPI, CMS Certification Number or CCN, or some otherway of identifying the name, location, and contact information of thefacility. The indication of the type of visit 416 may be a numericalcode indicating whether the visit was an emergency, an outpatient visit,an inpatient visit, and so forth.

Carrier claims 402 may include additional information not illustrated inFIG. 4, For example, carrier claims 402 may include an indication ofwhether the bill is being submitted through a government-funded plansuch as Medicare, Medicaid, Tricare, or CHAMPVA, or a private healthinsurance plan. The carrier claim 402 may include insurance information,such as the insured's ID number, name, address, birth date, policy name,group number, policy number, whether there is an additional healthbenefit plan, and so forth. The patient ID 406 information may includethe patient's name, address, telephone number, and so forth. The carrierclaim 402 may include an indication of whether the patient's conditionis related to employment, an automobile accident, or some otheraccident. The date of service 408 information may include an indicationof what date the current illness, injury, pregnancy, or other conditionbegan. The date of service 408 may further include other applicabledates. The carrier claim 402 may include information about what datesthe patient was unable to work in his or her current occupation, datesof hospitalization related to the current services, charges made to anoutside lab in relation to the current services, and so forth. Thecarrier claim 402 may include information about a referring provider orother source, such as the referring provider's individual NPI. Thebilling code 412 may include a diagnosis code or an indication of thenature of illness or injury and may further include a CPT or HCPCS codeindicating the procedures, services, or supplies used in connection withthe billed claim. For each billing code 412 listed in the carrier claim402, there is also an indication of the date of service, the place ofservice, the diagnosis pointer, the charges, the days or units, and therendering provider's practitioner ID 104 for that service, procedure, orsupply. The carrier claim 402 may further include a federal tax IDnumber for the practitioner 102, a patient account number relating tothe practitioner's practice, a total charge and the amount paid. Thecarrier claim 402 additionally includes information on the facilitywhere the service, procedure, or supply was administered to the patient.The information on the facility may include the name, address, contactinformation, or a clinic ID 108 or facility ID 112 related to thefacility.

Facility claims 404 may include additional information not illustratedin FIG. 4. The facility claims 404 may include all of the informationlisted above with reference to the carrier claims 402. The facilityclaims 404 may additionally include information on when the patient wasadmitted to the facility, the condition codes pertaining to why thepatient was admitted to the facility, and the dates the patient wasin-patient or out-patient at the facility. The facility claim 404 mayinclude numerous practitioner IDs 104 pertaining to each of the numerouspractitioners 102 who assisted in the patient's care while the patientwas at the facility 110. Each service, procedure, or supply administeredto the patient during the patient's stay at the facility 110 may linkedto a certain practitioner 102.

FIG. 5 is a schematic diagram of PECOS enrollment 502 informationrelationships. In the United States, the PECOS is used to track thestatus of healthcare practitioners, and the relationships thosehealthcare practitioners have with other entities, such as clinics 106,facilities 110, and groups 114. In the PECOS, a practitioner 102 isassigned a practitioner ID 104 in the form of an individual NPI.Additionally, other entities are assigned identification numbers. Aclinic 106 is assigned a clinic ID 108 in the form of an organizationNPI. A facility 110 is assigned a facility ID 112 in the form of a CMSCertification Number (CCN). A group 114 is assigned a group ID 116 inthe form of a PAC ID.

Within PECOS, a practitioner 102 can assign rights to another entity,such as a clinic 106, facility 110, and/or group 114 by storing areassignment file that links the practitioner's 102 practitioner ID 104to the clinic ID 108, the facility ID 112, and/or the group ID 116, asapplicable. The practitioner 102 can enroll under another entity, suchas the clinic 106, the facility 110, and/or the group 114. Thepractitioner 102 can submit an indication to PECOS that the practitioner102 is professionally associated with a clinic 106, facility 110, and/orgroup 114.

In an example, a practitioner is an emergency medicine physicianemployed by a hospital. The physician is enrolled in PECOS and suppliesan individual NPI, assigned previously by the National Plan and ProviderEnumeration System (NPPES). A PECOS Associate Control (PAC) ID isassigned to the practitioner, and an enrollment ID is assigned to eachof the practitioner's enrollments. Additionally, the hospital isenrolled in PECOS as a facility and supplies an NPI previously assigned.A PECOS Associate Control (PAC) ID is assigned to the facility, and anenrollment ID is assigned to each of the facility's enrollments. Thephysician may indicate within PECOS that the physician has assignedrights to the hospital, or that the physician is otherwise associatedwith the hospital, by linking one or more of his or her enrollment IDswith one or more enrollment IDs of the hospital in a reassignment file.

The PECOS enrollment 502 information is not always accurate. Theenrollment information within PECOS is often stale with respect toreal-world relationships. For example, a practitioner may transitionfrom being employed by a hospital to operating as a sole proprietor.This change is reflected in PECOS only if the practitioner or some otherentity indicates within PECOS that the change has occurred. In such aninstance, PECOS is not reliable to indicate the real-world professionalrelationships for that practitioner. In such an instance, the carrierclaims submitted by the practitioner can be analyzed in lieu of theinformation in PECOS, and the analysis gleaned from the carrier claimscan be used to override the information in PECOS to identify thepractitioner's real-world relationships.

FIG. 6 is a schematic flow chart diagram of a data flow 600 for matchingcarrier claims 402 to facilities 110 and/or facility claims 404 togenerate a matched data set. A computer does this by matching, in stepsor stages, various data points in a carrier claim to data points in afacility. In an embodiment, the facility claims 404 are processed withfacility IDs 112 and the carrier claims 402 are processed with thepractitioner's practitioner ID 104. The data flow 600 illustrates aplurality of matching iterations that may be completed in succession. Inan embodiment, one matching iteration is completed, and a subsequentmatching iteration is performed only on the remaining unmatched carrierclaims that were not matched in the prior matching iteration. In anembodiment, each of the matching iterations comprises one or moremetrics or variables that are used for the process of matching thefacility IDs 112 and practitioner IDs 104 in furtherance of generating amatched data set, and these metrics or variables are illustrated in FIG.6. The matched data set can be used to identify relationships betweenvarious healthcare entities.

In the data flow 600, the first metrics used in the merge processincludes the patient, service date, and the billing code 412. Thebilling code 412 may be an HCPCS (Healthcare Common Procedure CodingSystem) code (see 602). In the United States, HCPCS codes are used forbilling Medicare and Medicaid patients. The HCPCS codes are a collectionof codes that represent procedures, supplies, products, and serviceswhich may be provided to Medicare beneficiaries and to individualsenrolled in private health insurance programs. The data flow 600continues and the next metrics used in the merge process includes thepatient, service data, and the practitioner's practitioner ID 104 (see604). The data flow 600 continues and the next metric used in the mergeprocess includes the inpatient location if the carrier claim 402 occursduring a hospitalization at the facility 110 (see 606). The next metricsused in the merge process includes the service date and thepractitioner's most common facility (see 608). The next metric used inthe merge process includes the most common facility for the practitionerbased on the clinic ID 108 in the carrier claim 402 (see 610). The nextmetric used in the merge process is, again, the service date and thepractitioner's most common facility (see 612). The next metrics used inthe merge process include the service date and the practitioner's mostcommon facility within a two-week time period (see 614). The nextmetrics used in the merge process include, again, the service date andthe practitioner's most common facility (see 616). The next metric usedin the merge process includes the practitioner's most common providerwithin a two-week period using the previously joined facilities (see618). The next metric used in the merge process is the facility mostclosely attached to the clinic ID 108 based on the carrier claim 402(see 620).

FIG. 7 is a schematic diagram of a data framework for identifying abilling relationship between a practitioner 102 and a clinic 106. Theanalysis described in connection with FIG. 7 can be used to determine atwhat clinic(s) 106 a practitioner 102 is billing for services. Thebilling relationship between practitioners 102 and clinics 106 is basedon office-based carrier claims 402. In the United States, when apractitioner 102 bills Medicare for office-based services, a clinic ID108 is provided on the carrier claim 402. The practitioner-clinicbilling 704 relationship may be analyzed and quantified based on thedata associated with carrier claims 402. The practitioner-clinic billing704 relationship is measured by calculating the percentage of apractitioner's 102 total office-based claims that are billed under theclinic ID 108 associated with the clinic 106. If a practitioner 102bills more frequently under a first clinic than a second clinic, thepractitioner 102 is more strongly affiliated with the first clinic.

FIG. 8 is a schematic diagram of a dataflow for identifying anenrollment relationship between practitioners 102 and clinics 106. Theanalysis described in connection with FIG. 8 can be used to determineunder what clinic(s) 106 the practitioner 102 is enrolled. This isreferred to as the practitioner-clinic enrollment 708 relationship. Inthe United States, individuals and organizations participating inMedicare enroll in PECOS (Provider Enrollment and Chain/OwnershipSystem). PECOS is a system by which practitioners 102 can enroll in theMedicare healthcare system in the United States. A practitioner 102 mayenroll under PECOS using a practitioner ID 104 and may designateenrollment under one or more clinic IDs 108 associated with clinics 106or other organizations. When a practitioner 102 enrolls in PECOS, thepractitioner 102 is assigned a group ID 116 and/or system ID 120 (insome embodiments, the group ID 116 and the system ID 120 are the sameidentifier because the group and system are the same entity) whichserves as a unique individual professional identification forinteractions with PECOS enrollment 504.

When a practitioner ID 104 or a clinic ID 108 is enrolled in PECOSenrollment 504, the NPI is assigned a unique enrollment identification(ID). An enrollment ID can be used by a practitioner 102 to reassignbilling rights to an organization enrollment. A reassignment constitutesan enrollment relationship between a practitioner 102 and anorganization such as a clinic 106. Further in the Medicare systems inthe United States, each clinic 106 is enrolled under a group ID 116and/or system ID 120. Because each clinic 106 is associated with a PACID, and the PAC ID is additionally associated with a group or system,the enrollment relationship between practitioners 102 and clinics 106rolls up to groups 114 and systems 118 that are associated with PAC IDs.

A practitioner 102 may reassign to multiple organization enrollmentsunder different group IDs 116 and/or system IDs 120. In practice, theseenrollments are sometimes retained after a practitioner transitions to anew practice or clinic 106. Because some enrollments may be “stale” andmay no longer reflect the practitioner's 102 actual real-worldassociations, some enrollments may be discarded. Further, someenrollments may be used only infrequently. This may be the case when,for example, a practitioner 102 who reassigned rights to a specificclinic or group to have the ability to perform procedures for particularpatients. In current Medicare systems in the United States, there is noinformation available on how frequently an enrollment relationship isused by a practitioner 102 other than through billing relationships asdiscussed in connection with FIG. 7. For this reason, enrollmentrelationships may be used only to roll clinic 106 locations up to groups114 or systems 118 when necessary.

In an embodiment, an enrollment relationship between a practitioner 102and a clinic 106 is identified by retrieving distinct practitioner ID104 and clinic ID 108 relationships from enrollment and reassignmentfiles over time. This analysis can result in determining a practitionerenrollment metric and a clinic enrollment metric. The practitionerenrollment metric identifies one or more clinics 106 at which apractitioner 102 in enrolled in Medicare in the United States. Theclinic enrollment metric identifies one or more practitioners 102 thathave enrolled in Medicare under a certain clinic 106.

FIG. 9 is a schematic diagram of a data flow for analyzing ownershiprelationships between clinics 106 and groups 114. The analysis discussedin connection with FIG. 9 can be used to identify group(s) 114 that ownone or more clinics 106. This is referred to as the clinic-groupownership 710. In the framework 100 described herein, clinics 106 areowned by groups 114. A group 114 is represented by a group ID 116. Inmany cases, a clinic ID 108 associated with a clinic 106 appears in anenrollment file for the group 114 with the group ID 116 statedexplicitly.

In some cases, the clinic ID 108 for a clinic 106 is not included inPECOS enrollment 504. In these cases, a group ID 116 may be inferredbased on enrollment relationships of practitioners 102 to clinics 106.In an embodiment, when more than 50% of practitioners 102 (weighted bythe practitioners 102 billing relationship to the clinic 106) enrollunder a group ID 116, that group ID 116 is imputed to the owner of theclinic ID 108 for the clinic 106. Alternatively, a group ID 116 may beimputed to the owner of the clinic ID 108 for the clinic 106 if thegroup ID's 116 squared proportion of provider enrollments exceeds 50% ofthe sum of the squared proportions of all enrollments for the clinics'106 billing practitioners 102 (weighted by the practitioners 102 billingrelationship to the clinic 106). A portion of these cases have a perfectownership relationship wherein all billing practitioners reassign to thesame group ID 116. In some cases, a clinic 106 has less than perfectownership when the group ID 116 is imputed to the clinic 106.

In an embodiment, the clinic-group ownership 710 is determined based oncarrier claims 402 and data retrieved from the PECOS enrollment 504. Insome cases, the clinic ID 108 for the clinic 106 may be identified basedon clinic enrollment to retrieve the group ID 116. Where no enrollmentexists for the clinic 106, a method includes using reassignmentsindicated in PECOS enrollment 504 of the practitioners 102 to impute agroup ID 116 to the clinic 106. In an embodiment, the reassigned groupIDs 116 for practitioners 102 billing carrier claims 402 under a clinicID 108 are identified using the enrollment and reassignment files. Theproportion of all clinic ID 108 and group ID 116 combinationsrepresented by each combination are calculated. The proportions may beweighted by the practitioner's 102 billing relationships and by thenumber of claims a practitioner 102 bills at the clinic 106. The levelof concentration each practitioner 102 shares with each clinic ID 108 iscalculated by taking the sum of the squared proportions.

In an embodiment, a certain group ID 116 and clinic ID 108 combinationis selected if the combination has more than 50% of the reassignments ofthe clinic's 106 practitioners. This can be determined by using theenrollment and reassignment files to identify the reassigned group IDs116 of practitioners 102 who bill carrier claims 402 under a clinic ID108. In an embodiment, a certain group ID 116 and clinic ID 108combination is selected if the combination has a squared proportiongreater than 50% of the concentration of a practitioner's 102 shareswithin the clinic 106. This can be calculated by taking the sum of thesquared proportions as done in the Herfindahl-Hirschman Index.

The metrics pertaining to the clinic-group ownership 710 includepractitioner group billing and group billing. The practitioner groupbilling is the proportion of the practitioner's 102 office claims billedunder any of a group's 114 clinics 106. The group billing is theproportion of all office claims billed under any of the group's 114clinics 106 that were performed by a specific practitioner 102.

FIG. 10 is a schematic diagram of a method for identifying andquantifying the practitioner-facility relationship with respect toprocedures. The analysis discussed in connection with FIG. 10 can beused to determine at what facilities 110 a practitioner 102 isperforming procedures. This is referred to as the practitioner-facilityprocedures 714 metric. When a practitioner 102 performs a procedure at afacility 110, a facility claim 404 is submitted that includes thepractitioner's 102 practitioner ID 104, and clinic ID 108 for anassociated clinic 106, and a CMS Certification Number (facility ID). Insome embodiments, the facility ID 112 is a CMS provider number. Theproportion of procedures performed by a practitioner at a certainfacility 110 is quantified based on the relationship in the claimsbetween practitioner IDs and facility IDs. Further, the proportion ofthe facility's 110 procedure volume that were performed by a certainpractitioner 102 is quantified based on the relationship in the claimsbetween practitioner IDs 104 and facility IDs 112. These procedurevolumes provide a link between practitioners 102 and facilities 110apart from any official ownership or employment relationships.

The raw data input includes all facility claims 404 files such asinpatient, outpatient, hospice, and so forth. The practitioner-facilityprocedure 714 is determined by identifying the distinct NPIs thatparticipated in each claim. This can be performed for each claim in agiven year. Participating entities are denoted in the attending,operating, rendering, and other identifier fields within the facilityclaims 404. An identifier (e.g., a National Provider Identifier (NPI))can appear in more than one of these fields and the duplicates should behandled when calculating the practitioner-facility procedures 714metric. For each pair including a participating practitioner 102 and afacility 110, the number of claims represented by the pair is counted.The claim numbers by distinct pair are summed across all claim files.This process may be repeated for each year of available claims data.

The practitioner-facility procedures 714 metrics results in apractitioner facility procedure volume metric and a facility procedurevolume metric. The practitioner facility procedure volume metric is theproportion of a practitioner's total procedure claims performed at acertain facility. A practitioner's procedure claim is a claim in whichthe practitioner participated in the procedure. The facility procedurevolume is the proportion of procedures performed at a certain facilityby each of one or more practitioners using the certain facility.

FIG. 11 is a schematic diagram of a data flow for identifying employmentrelationships between practitioners and facilities. The analysisdiscussed in connection with FIG. 11 can be used to determine whatfacilities directly employ a practitioner. This is referred to as thepractitioner-facility employment 716 metric. When a practitioner isdirectly employed by a facility, the practitioner's billed claims willlikely be processed by the facility. In such an instance, the facilitymight submit a bill including facility charges and practitioner charges,and the practitioner does not send a separate bill. This billingrelationship impacts the dynamic between the practitioner and thefacility, and further impacts the dynamics between the practitioner andother entities such as healthcare groups, healthcare systems, healthinsurance agencies, patients, and so forth. Therefore, it can beimportant to understand whether a practitioner 102 has a directemployment relationship with a facility 110.

In some cases, a practitioner 102 is employed directly by a facility110. This is distinct from practitioners 102 who practice exclusively atthe facility 110. In an embodiment, to determine employment,office-based claims with facility IDs (Centers for Medicare and MedicaidServices (CMS) Certification Numbers) 112 are matched using a multiplestep matching process. The proportion of a practitioner's total carrierclaims 402 performed in a facility is calculated based on the result ofthe multiple step matching process.

In some instances, a practitioner 102 is paid less on an office-basedclaim if there is a facility fee associated with the claim. This occursbecause the facility 110 is also billing for the service. The total ofthe practitioner's fee and the facility fee in these cases is generallyhigher than the practitioner's fee would be alone at a non-facilitysetting. Identifying this scenario can lead to concluding thatpractitioners 102 billing office claims at a facility 110 are employedby the facility. When performing this analysis on typical real-worlddata, the analysis confirms that a majority of practitioners bill allcarrier claims 402 or no carrier claims 402 under a facility 110. In anembodiment, practitioners with claims that are all matched to a facilityare deemed employed by that facility.

The practitioner-facility employment 716 determination can be performedbased on a claims analysis file. The claims analysis file is generatedbased on claims analytics and practitioner affiliations. The claimsanalytics and practitioner affiliations are identified based on billedclaims. In an embodiment, the practitioner-facility employment 716determination is calculated at least in part based on the result of amultiple step data merging process for matching facility claims 404(facility IDs) to carrier claims 402. The data merging process occurs byattempting to match unmatched carrier claims 402 from a prior step topractitioners using one or more of the following variables. A possiblevariable is the patient, service data, and HCPCS (Healthcare CommonProcedure Coding System) code. The HCPCS code may alternatively bereferred to as a “procedure code” herein. A further possible variable isthe patient, service date, and practitioner NPI. A further possiblevariable is the match based on inpatient location if the carrier claimoccurs during a hospitalization and is then matched to that facility. Afurther possible variable is the service date and the practitioner'smost common facility. A further possible variable is the most commonfacility based on the clinic ID in the carrier claim 402. A furtherpossible variable is the service date and the practitioner's most commonfacility. A further possible variable is the service date and thepractitioner's most common facility within a two-week range. A furtherpossible variable is the service date and the practitioner's most commonfacility. A further possible variable is the practitioner's most commonprovider within two weeks using the previously joined facilities. Afurther possible variable is the facility that is most closely attachedwith the clinic ID from the carrier claim.

In an embodiment, the facility claims 404 (facility IDs accessible viaPECOS enrollment 504) are matched to carrier claims 402 using thefollowing 10-step merge process. The merge occurs by attempting to matchunmatched carrier claims 402 from the prior step to practitioners 102using the following variables:

-   -   a. Patient, service date, and HCPCS code;    -   b. Patient, service date, and practitioner's practitioner ID;    -   c. Inpatient location if the carrier claim occurs during a        hospitalization at the facility;    -   d. Service date and practitioner's most common facility;    -   e. Most common facility based on the clinic ID in the carrier        claim;    -   f. Service date and the practitioner's most common facility        (again);    -   g. Service date and the practitioner's most common facility        within a two-week time period;    -   h. Service date and the practitioner's most common facility        (again);    -   i. Practitioner's most common provider within two weeks, using        the previously joined facilities; and    -   j. The facility most closely attached to the clinic ID from the        carrier claim.

When the data has been merged, a method may further include calculatingthe percentage of a practitioner's 102 office claims that occurred at afacility 110 by collapsing the practitioner's practitioner ID 104 andthe facility's clinic ID 108. In an embodiment, office claims that havea place of service code equal to eleven (office-based claims) ortwenty-two (hospital outpatient department claims) are used to determineemployment. The proportion of such claims that have place of servicecode twenty-two represents the strength of the practitioner's 102employment relationship with the facility 110. A method may furtherinclude collapsing to the clinic 106 or group 114 level and saving apercent of the group's 114 practitioners 102 that are employed byfacilities or systems. This can be performed for all years of availableclaims.

The merge process for matching carrier claims 402 to a facility 110and/or facility claims 404 is a novel data manipulation process that isperformed on a very large set of data. The number of carrier claims 402,facilities 110, and facility claims 404 can be enormous for a singularcalendar year. This number of claims is impossible for a single human orgroup of humans to process, and particularly within the same calendaryear of the billed claims. The merge process is a novel set of rulesspecifying how a computer should match carrier claims 402 to a facility110 and or to facility claims 404.

In an embodiment, the carrier claims 402, the facility IDs 112, and thefacility claims 404 are stored in a database. The data (i.e., thecombination of the carrier claims 402, the facility IDs 112, and thefacility claims 404) is typically retrieved from larger files or datastores and includes superfluous information that is not necessary foridentifying and quantifying the practitioner-facility employment 716relationship. The data is therefore cleaned prior to storage in thedatabase. The data is cleaned such that 10-step matching process can beperformed on a manageable sum of data. In an embodiment, the data isequivalent to about 1 terabyte (TB) of data per claim year.

In an embodiment, the cleaned data is linked to a database platform. Thedatabase platform is in communication with a user interface (UI) suchthat the data can be viewed seamlessly. The data can be partitionedwithin the database based on calendar year, entity, practitioner 102,facility 110, facility ID 112, carrier claim 402, facility claim 404,and so forth. The database platform is built on highly modeled, asopposed to raw, data sources.

In an embodiment, as information stored in the database is changed, thepractitioner-facility employment 716 metric is reevaluated. A change tothe information stored in the database may reflect that a new facility110 is added, a new practitioner 102 is added, there is a newrelationship between a practitioner and a facility, there are new claimssubmitted, and so forth. The practitioner-facility employment 716 metricmay be reevaluated to determine whether a new employment relationshiphas been formed, an employment relationship has been discontinued, or anemployment relationship has changed. This reevaluation can be performedin real-time as the data as changed and can therefore provide anup-to-date and reliable representation of the real-world relationshipsbetween practitioners and facilities. Conducting this analysis by hand(by the human mind) in real-time would be so impractical that it couldbe considered impossible.

FIG. 12 is a schematic diagram of a data framework for identifying andquantifying the ownership relationship between a facility 110 and asystem 118. The analysis described in connection with FIG. 12 can beused to determine what system owns a facility, and which facilities areowned by the system. The resulting metric is referred to as thefacility-system ownership 718 metric.

The ownership relationship between a system 118 and one or morefacilities 110 can be assessed using the enrollment file andclaims-based link between clinic IDs and facility IDs. A facility claim404 can include clinic IDs 108 and facility IDs 112 for the facilities110 at which a practitioner 102 performs procedures. The distinctcombinations of clinic ID 108 and facility ID 112 allow for a linkbetween these two identifiers. In some instances, multiple clinic IDs108 roll up to one system ID 120, and this typically indicates adifferent department within the facility or a change of ownership. Insome instances, multiple facility IDs 112 link to the same clinic ID108, and this typically occurs when a facility 110 makes a transition,such as an acute care hospital gaining critical access status. However,in most instances, clinic IDs 108 and facility IDs 112 match one-to-one.Using all facility ID 112 to clinic ID 108 matches and the PECOSenrollment 504 file (which contains enrollment of clinic IDs 108 undercorresponding system IDs 120), a facility ID 112 can be rolled up to asystem ID 120 in an ownership relationship. Further research can beperformed to identify parent companies.

In an embodiment, the data inputs for identifying the facility-systemownership 718 relationship is the facility claims 404 for a facility 110and the PECOS enrollment 504 file for the facility 110 and/or system118. A method for determining the facility-system ownership 718relationship includes one or more of the following steps. The methodincludes using the facility claims 404 to match facility IDs 112 toclinic IDs 108 for each claim year. The method includes using enrollmentinformation from the PECOS enrollment 504 file to match clinic IDs 108to system IDs 120. The method includes handling duplications such assystem IDs 120 that may be owned by common parent organizations.

The facility system-ownership 718 relationship can be leveraged toidentify multiple metrics, including the practitioner-system employmentmetric, the practitioner-system procedure volume metric, and the systemprocedure volume metric. The practitioner-system employment metric is alevel of confidence that a practitioner 102 is employed by a system 118.The practitioner-system procedure volume is a proportion of allprocedure claims in which the practitioner 102 participated that wereperformed at the system 118. The system procedure volume is a proportionof all procedures performed at a system 118 in which the practitioner102 participated.

FIG. 13 is a schematic diagram of a data framework for identifying andquantifying the geographic proximity between a facility 110 and a clinic106. The analysis described in connection with FIG. 13 can be used todetermine how the geographic proximity of facilities 110 and clinics 106that are affiliated under group IDs 116 and/or system IDs 120. Thisdetermination is referred to as the facility-clinic location 726 metric.

When facilities 110 and clinics 106 do not have an identity relationshipby using a clinic ID 108 equal to a facility ID 112 of the same type(for example, a common NPI), the facilities and clinics may still begeographically located at the same location or in close geographicproximity to one another. This geographic proximity, together with otherkinds of affiliation, can provide an indication of which entities withina network are likely to be operating together, even if the entities arenot billing together or enrolling together under PECOS enrollment 504. Ageographic distance measure can shed light on which practitioners 102have an office at a given facility 110 in a geographic sense, even ifnot in an official sense. Address geocoding can be read from the NPPES(National Plan & Provider Enumeration System) and Provider of Services724 files to assess geographic proximity.

In an embodiment, the data input for determining the facility-cliniclocation 726 metric is the carrier claims 402 of a practitioner 102, thefacility claims 710 of a facility 110, and information pulled from PECOSenrollment 504. The information stored in carrier claims 402 can beassessed to identify whether there is a clinic-group ownership 710relationship. The facility claims 404 can be assessed to identifywhether there is a facility-system ownership 718 relationship. Theinformation pulled from the PECOS enrollment 504 can be assessed toidentify whether there is a clinic-group ownership 710 relationship,whether there is a facility-system ownership 718 relationship, whetherthere is a group-system identity 720 relationship, and/or whether thereis a facility-clinic identity 722 relationship. The information storedin the NPPES and Provider of Services 724 files can be assessed, alongwith the other assessment to identify the facility-clinic location 726relationship.

In an embodiment, a method for determining a facility-clinic location726 relationship includes the following steps. The method includes, forclinics 106 and facilities 110 that have a common group ID 116 and/orsystem ID 120 ownership, use geocoding of addresses in the NPPES,Provider of Services 724 file (for facilities 110) and the NPPESregistry (for clinics 106) to assess the geographic proximity betweenthe clinics 106 and the facilities 110. The resulting facility-cliniclocation 726 metric is an indication of a geographic distance between aclinic 106 and a facility 110. The distance may be recorded in miles,kilometers, or some other suitable measurement.

FIG. 14 is a schematic flow chart diagram of a method 1400 for matchinghealthcare claims data. The method 1400 may be performed by a computingresource configurable to execute instructions stored in non-transitorycomputer readable storage media. In an embodiment, the method 1400 isexecuted by the data merging component 202.

The method 1400 begins and a computing resource identifies at 1402 acarrier claim processed by a practitioner. The step of identifying thecarrier claim may include identifying a plurality of carrier claimsprocessed by the practitioner over a time period, for example over onecalendar year. The step of identifying the carrier claim may furtherinclude identifying only carrier claims in which the practitionerperformed a procedure at a facility or clinic. The method 1400 continuesand a computing resource matches at 1404 the carrier claim to a facilityto generate a matched claim based on a claims factor. The step ofmatching the carrier claim to the facility may include matching aplurality of carrier claims to one or more facilities as deemedappropriate based on the claims factor. The step of matching the carrierclaim to the facility may further include matching a plurality ofcarrier claims to a plurality of facility claims, wherein the facilityclaims are processed by the facility over the time period.

The method 1400 continues and a computing resources matches at 1404 thecarrier claim to the facility based on one or more of the followingclaims factors (see 1406), including: a patient identifier, a date ofservice for a procedure billed on the carrier claim, a practitioneridentifier associated with the practitioner, a facility identifier foran inpatient facility associated with the carrier claim if the carrierclaim occurred during a hospitalization at the inpatient facility, or amost common facility associated with the practitioner.

Referring now to FIG. 15, a block diagram of an example computing device1500 is illustrated. Computing device 1500 may be used to performvarious procedures, such as those discussed herein. Computing device1500 can perform various monitoring functions as discussed herein, andcan execute one or more application programs, such as the applicationprograms or functionality described herein. Computing device 1500 can beany of a wide variety of computing devices, such as a desktop computer,in-dash computer, vehicle control system, a notebook computer, a servercomputer, a handheld computer, tablet computer and the like.

Computing device 1500 includes one or more processor(s) 1504, one ormore memory device(s) 1504, one or more interface(s) 1506, one or moremass storage device(s) 1508, one or more Input/output (I/O) device(s)1510, and a display device 1530 all of which are coupled to a bus 1512.Processor(s) 1504 include one or more processors or controllers thatexecute instructions stored in memory device(s) 1504 and/or mass storagedevice(s) 1508. Processor(s) 1504 may also include various types ofcomputer-readable media, such as cache memory.

Memory device(s) 1504 include various computer-readable media, such asvolatile memory (e.g., random access memory (RAM) 1514) and/ornonvolatile memory (e.g., read-only memory (ROM) 1516). Memory device(s)1504 may also include rewritable ROM, such as Flash memory.

Mass storage device(s) 1508 include various computer readable media,such as magnetic tapes, magnetic disks, optical disks, solid-statememory (e.g., Flash memory), and so forth. As shown in FIG. 15, aparticular mass storage device 1508 is a hard disk drive 1524. Variousdrives may also be included in mass storage device(s) 1508 to enablereading from and/or writing to the various computer readable media. Massstorage device(s) 1508 include removable media 1526 and/or non-removablemedia.

I/O device(s) 1510 include various devices that allow data and/or otherinformation to be input to or retrieved from computing device 1500.Example I/O device(s) 1510 include cursor control devices, keyboards,keypads, microphones, monitors or other display devices, speakers,printers, network interface cards, modems, and the like.

Display device 1530 includes any type of device capable of displayinginformation to one or more users of computing device 1500. Examples ofdisplay device 1530 include a monitor, display terminal, videoprojection device, and the like.

Interface(s) 1506 include various interfaces that allow computing device1500 to interact with other systems, devices, or computing environments.Example interface(s) 1506 may include any number of different networkinterfaces 1520, such as interfaces to local area networks (LANs), widearea networks (WANs), wireless networks, and the Internet. Otherinterface(s) include user interface 1518 and peripheral device interface1522. The interface(s) 1506 may also include one or more user interfaceelements 1518. The interface(s) 1506 may also include one or moreperipheral interfaces such as interfaces for printers, pointing devices(mice, track pad, or any suitable user interface now known to those ofordinary skill in the field, or later discovered), keyboards, and thelike.

Bus 1512 allows processor(s) 1504, memory device(s) 1504, interface(s)1506, mass storage device(s) 1508, and I/O device(s) 1510 to communicatewith one another, as well as other devices or components coupled to bus1512. Bus 1512 represents one or more of several types of busstructures, such as a system bus, PCI bus, IEEE bus, USB bus, and soforth.

EXAMPLES

The following examples pertain to further embodiments.

Example 1 is a method. The method includes identifying a carrier claimprocessed by a practitioner and matching the carrier claim to a facilityto generate a matched claim based on a claims factor. The method is suchthat the claims factor comprises one or more of a patient identifier; adate of service for a procedure billed on the carrier claim; apractitioner identifier associated with the practitioner; a facilityidentifier for an inpatient facility associated with the carrier claimif the carrier claim occurred during a hospitalization at the inpatientfacility; or a most common facility associated with the practitioner.

Example 2 is a method as in Example 1, wherein identifying the carrierclaim comprises identifying a plurality of carrier claims processed bythe practitioner over a time period, and wherein the method furthercomprises identifying a plurality of facility claims processed by thefacility over the time period.

Example 3 is a method as in any of Examples 1-2, wherein matching thecarrier claim to the facility comprises matching at least one of theplurality of carrier claims to at least one of the plurality of facilityclaims based on the claims factor to generate one or more matchedclaims.

Example 4 is a method as in any of Examples 1-3, further comprising:calculating a percentage of outpatient claims based on a percentage ofoffice claims performed by the practitioner that did not occur at thefacility by collapsing the one or more matched claims on a practitioneridentifier associated with the practitioner; and calculating a level ofconfidence the practitioner is employed by the facility based on the oneor more matched claims and the percentage of outpatient claims.

Example 5 is a method as in any of Examples 1-4, further comprising:collapsing the one or more matched claims to a group level, wherein thefacility is a healthcare facility associated with a healthcare group;and calculating a percentage of employment by calculating a percentageof practitioners associated with the healthcare group that are employedby a facility associated with the healthcare group.

Example 6 is a method as in any of Examples 1-5, wherein matching thecarrier claim to the facility comprises matching based on: in a firstmatching iteration, a patient identifier for a patient that received aprocedure from the practitioner, a date of service for the procedureperformed, and a procedure code for the procedure; in a second matchingiteration, the patient identifier, the date of service, and anpractitioner ID (National Provider Identifier) associated with thepractitioner; in a third matching iteration, an inpatient facilityassociated with a carrier claim if the carrier claim occurred during ahospitalization at the inpatient facility; in a fourth matchingiteration, the date of service and a most common facility associatedwith the practitioner; and in a fifth matching iteration, the mostcommon facility associated with the practitioner as determined based onan clinic ID (National Provider Identifier) in a carrier claim.

Example 7 is a method as in any of Examples 1-6, wherein matching thecarrier claim to the facility comprises matching based on: in a sixthmatching iteration, the date of service and the most common facilityassociated with the practitioner; in a seventh matching iteration, thedate of service and recent most common facility associated with thepractitioner based on claims processed by the practitioner in a recenttime period; in an eighth matching iteration, the date of service andthe most common facility associated with the practitioner; in a ninthmatching iteration, a most common facility associated with thepractitioner using previously joined facilities; and in a tenth matchingiteration, a facility most closely link to the clinic ID based on thecarrier claim.

Example 8 is a method as in any of Examples 1-7, wherein matching thecarrier claim to the facility comprises matching a plurality of carrierclaims billed by the practitioner over a time period to one or morefacilities.

Example 9 is a method as in any of Examples 1-8, wherein: matching theplurality of carrier claims to the one or more facilities comprisesperforming a plurality of independent matching iterations in succession,wherein the plurality of independent matching iterations comprises thefirst matching iteration, the second matching iteration, the thirdmatching iteration, the fourth matching iteration, the fifth matchingiteration, the sixth matching iteration, the seventh matching iteration,the eight matching iteration, the ninth matching iteration, and thetenth matching iteration; and for each matching iteration of theplurality of independent matching iterations, matching previouslyunmatched carrier claims of the plurality of carrier claims to afacility of the one or more facilities based on one or more claimsfactors in an instant matching iteration.

Example 10 is a method as in any of Examples 1-9, wherein the claimsfactor comprises each of: the patient identifier, wherein the patientidentifier is associated with a patient that received a procedure fromthe practitioner; the date of service for the procedure billed on thecarrier claim; a procedure code for the procedure billed on the carrierclaim; the practitioner identifier associated with the practitioner,wherein the practitioner identifier is an individual National ProviderIdentifier; the facility identifier for the inpatient facility if theprocedure billed on the carrier claim occurred during a hospitalizationat the inpatient facility, wherein the facility identifier is a CMSCertification Number; the most common facility associated with thepractitioner based on a plurality of carrier claims billed by thepractitioner; a clinic identifier associated with the facility, whereinthe clinic identifier is an organization National Provider Identifier;and a facility most commonly linked to the clinic identifier based onthe plurality of carrier claims billed by the practitioner.

Example 11 is a system comprising one or more processors for executinginstructions stored in non-transitory computer readable storage media,wherein the instructions comprise any of the method steps in Examples1-10.

Example 12 is non-transitory computer readable storage media storinginstructions for execution by one or more processors, wherein theinstructions comprise any of the method steps in Examples 1-10.

In the above disclosure, reference has been made to the accompanyingdrawings, which form a part hereof, and in which is shown by way ofillustration specific implementations in which the disclosure may bepracticed. It is understood that other implementations may be utilized,and structural changes may be made without departing from the scope ofthe present disclosure. References in the specification to “oneembodiment,” “an embodiment,” “an example embodiment,” etc., indicatethat the embodiment described may include a particular feature,structure, or characteristic, but every embodiment may not necessarilyinclude the particular feature, structure, or characteristic. Moreover,such phrases are not necessarily referring to the same embodiment.Further, when a particular feature, structure, or characteristic isdescribed in connection with an embodiment, it is submitted that it iswithin the knowledge of one skilled in the art to affect such feature,structure, or characteristic in connection with other embodimentswhether or not explicitly described.

Implementations of the systems, devices, and methods disclosed hereinmay comprise or utilize a special purpose or general-purpose computerincluding computer hardware, such as, for example, one or moreprocessors and system memory, as discussed herein. Implementationswithin the scope of the present disclosure may also include physical andother computer-readable media for carrying or storingcomputer-executable instructions and/or data structures. Suchcomputer-readable media can be any available media that can be accessedby a general purpose or special purpose computer system.Computer-readable media that store computer-executable instructions arecomputer storage media (devices). Computer-readable media that carrycomputer-executable instructions are transmission media. Thus, by way ofexample, and not limitation, implementations of the disclosure cancomprise at least two distinctly different kinds of computer-readablemedia: computer storage media (devices) and transmission media.

Computer storage media (devices) includes RAM, ROM, EEPROM, CD-ROM,solid state drives (“SSDs”) (e.g., based on RAM), Flash memory,phase-change memory (“PCM”), other types of memory, other optical diskstorage, magnetic disk storage or other magnetic storage devices, or anyother medium, which can be used to store desired program code means inthe form of computer-executable instructions or data structures andwhich can be accessed by a general purpose or special purpose computer.

An implementation of the devices, systems, and methods disclosed hereinmay communicate over a computer network. A “network” is defined as oneor more data links that enable the transport of electronic data betweencomputer systems and/or modules and/or other electronic devices. Wheninformation is transferred or provided over a network or anothercommunications connection (either hardwired, wireless, or a combinationof hardwired or wireless) to a computer, the computer properly views theconnection as a transmission medium. Transmissions media can include anetwork and/or data links, which can be used to carry desired programcode means in the form of computer-executable instructions or datastructures and which can be accessed by a general purpose or specialpurpose computer. Combinations of the above should also be includedwithin the scope of computer-readable media.

Computer-executable instructions comprise, for example, instructions anddata which, when executed at a processor, cause a general-purposecomputer, special purpose computer, or special purpose processing deviceto perform a certain function or group of functions. The computerexecutable instructions may be, for example, binaries, intermediateformat instructions such as assembly language, or even source code.Although the subject matter has been described in language specific tostructural features and/or methodological acts, it is to be understoodthat the subject matter defined in the appended claims is notnecessarily limited to the described features or acts described above.Rather, the described features and acts are disclosed as example formsof implementing the claims.

Those skilled in the art will appreciate that the disclosure may bepracticed in network computing environments with many types of computersystem configurations, including, an in-dash vehicle computer, personalcomputers, desktop computers, laptop computers, message processors,hand-held devices, multi-processor systems, microprocessor-based orprogrammable consumer electronics, network PCs, minicomputers, mainframecomputers, mobile telephones, PDAs, tablets, pagers, routers, switches,various storage devices, televisions, and the like. The disclosure mayalso be practiced in distributed system environments where local andremote computer systems, which are linked (either by hardwired datalinks, wireless data links, or by a combination of hardwired andwireless data links) through a network, both perform tasks. In adistributed system environment, program modules may be located in bothlocal and remote memory storage devices.

Further, where appropriate, functions described herein can be performedin one or more of: hardware, software, firmware, digital components, oranalog components. For example, one or more application specificintegrated circuits (ASICs) can be programmed to carry out one or moreof the systems and procedures described herein. Certain terms are usedthroughout the description and claims to refer to particular systemcomponents. The terms “modules” and “components” are used in the namesof certain components to reflect their implementation independence insoftware, hardware, circuitry, sensors, or the like. As one skilled inthe art will appreciate, components may be referred to by differentnames. This document does not intend to distinguish between componentsthat differ in name, but not function.

It should be noted that the sensor embodiments discussed above maycomprise computer hardware, software, firmware, or any combinationthereof to perform at least a portion of their functions. For example, asensor may include computer code configured to be executed in one ormore processors and may include hardware logic/electrical circuitrycontrolled by the computer code. These example devices are providedherein purposes of illustration and are not intended to be limiting.Embodiments of the present disclosure may be implemented in furthertypes of devices, as would be known to persons skilled in the relevantart(s).

At least some embodiments of the disclosure have been directed tocomputer program products comprising such logic (e.g., in the form ofsoftware) stored on any computer useable medium. Such software, whenexecuted in one or more data processing devices, causes a device tooperate as described herein.

While various embodiments of the present disclosure have been describedabove, it should be understood that they have been presented by way ofexample only, and not limitation. It will be apparent to persons skilledin the relevant art that various changes in form and detail can be madetherein without departing from the spirit and scope of the disclosure.Thus, the breadth and scope of the present disclosure should not belimited by any of the above-described exemplary embodiments but shouldbe defined only in accordance with the following claims and theirequivalents. The foregoing description has been presented for thepurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure to the precise form disclosed.Many modifications and variations are possible in light of the aboveteaching. Further, it should be noted that any or all of theaforementioned alternate implementations may be used in any combinationdesired to form additional hybrid implementations of the disclosure.

Further, although specific implementations of the disclosure have beendescribed and illustrated, the disclosure is not to be limited to thespecific forms or arrangements of parts so described and illustrated.The scope of the disclosure is to be defined by the claims appendedhereto, any future claims submitted here and in different applications,and their equivalents.

What is claimed is:
 1. A method comprising: identifying a carrier claimprocessed by a practitioner; and matching the carrier claim to afacility to generate a matched claim based on a claims factor; whereinthe claims factor comprises one or more of: a patient identifier; a dateof service for a procedure billed on the carrier claim; a practitioneridentifier associated with the practitioner; a facility identifier foran inpatient facility associated with the carrier claim if the carrierclaim occurred during a hospitalization at the inpatient facility; or amost common facility associated with the practitioner.
 2. The method ofclaim 1, wherein identifying the carrier claim comprises identifying aplurality of carrier claims processed by the practitioner over a timeperiod, and wherein the method further comprises identifying a pluralityof facility claims processed by the facility over the time period. 3.The method of claim 2, wherein matching the carrier claim to thefacility comprises matching at least one of the plurality of carrierclaims to at least one of the plurality of facility claims based on theclaims factor to generate one or more matched claims.
 4. The method ofclaim 3, further comprising: calculating a percentage of outpatientclaims based on a percentage of office claims performed by thepractitioner that did not occur at the facility by collapsing the one ormore matched claims on a practitioner identifier associated with thepractitioner; and calculating a level of confidence the practitioner isemployed by the facility based on the one or more matched claims and thepercentage of outpatient claims.
 5. The method of claim 4, furthercomprising: collapsing the one or more matched claims to a group level,wherein the facility is a healthcare facility associated with ahealthcare group; and calculating a percentage of employment bycalculating a percentage of practitioners associated with the healthcaregroup that are employed by a facility associated with the healthcaregroup.
 6. The method of claim 1, wherein matching the carrier claim tothe facility comprises matching based on: in a first matching iteration,a patient identifier for a patient that received a procedure from thepractitioner, a date of service for the procedure performed, and aprocedure code for the procedure; in a second matching iteration, thepatient identifier, the date of service, and an practitioner ID(National Provider Identifier) associated with the practitioner; in athird matching iteration, an inpatient facility associated with acarrier claim if the carrier claim occurred during a hospitalization atthe inpatient facility; in a fourth matching iteration, the date ofservice and a most common facility associated with the practitioner; andin a fifth matching iteration, the most common facility associated withthe practitioner as determined based on an clinic ID (National ProviderIdentifier) in a carrier claim.
 7. The method of claim 6, whereinmatching the carrier claim to the facility comprises matching based on:in a sixth matching iteration, the date of service and the most commonfacility associated with the practitioner; in a seventh matchingiteration, the date of service and recent most common facilityassociated with the practitioner based on claims processed by thepractitioner in a recent time period; in an eighth matching iteration,the date of service and the most common facility associated with thepractitioner; in a ninth matching iteration, a most common facilityassociated with the practitioner using previously joined facilities; andin a tenth matching iteration, a facility most closely link to theclinic ID based on the carrier claim.
 8. The method of claim 7, whereinmatching the carrier claim to the facility comprises matching aplurality of carrier claims billed by the practitioner over a timeperiod to one or more facilities.
 9. The method of claim 8, wherein:matching the plurality of carrier claims to the one or more facilitiescomprises performing a plurality of independent matching iterations insuccession, wherein the plurality of independent matching iterationscomprises the first matching iteration, the second matching iteration,the third matching iteration, the fourth matching iteration, the fifthmatching iteration, the sixth matching iteration, the seventh matchingiteration, the eight matching iteration, the ninth matching iteration,and the tenth matching iteration; and for each matching iteration of theplurality of independent matching iterations, matching previouslyunmatched carrier claims of the plurality of carrier claims to afacility of the one or more facilities based on one or more claimsfactors in an instant matching iteration.
 10. The method of claim 1,wherein the claims factor comprises each of: the patient identifier,wherein the patient identifier is associated with a patient thatreceived a procedure from the practitioner; the date of service for theprocedure billed on the carrier claim; a procedure code for theprocedure billed on the carrier claim; the practitioner identifierassociated with the practitioner, wherein the practitioner identifier isan individual National Provider Identifier; the facility identifier forthe inpatient facility if the procedure billed on the carrier claimoccurred during a hospitalization at the inpatient facility, wherein thefacility identifier is a CMS Certification Number; the most commonfacility associated with the practitioner based on a plurality ofcarrier claims billed by the practitioner; a clinic identifierassociated with the facility, wherein the clinic identifier is anorganization National Provider Identifier; and a facility most commonlylinked to the clinic identifier based on the plurality of carrier claimsbilled by the practitioner.
 11. A system comprising one or moreprocessors for executing instructions stored in non-transitory computerreadable storage media, the instructions comprising: identifying acarrier claim processed by a practitioner; and matching the carrierclaim to a facility to generate a matched claim based on a claimsfactor; wherein the claims factor comprises one or more of: a patientidentifier; a date of service for a procedure billed on the carrierclaim; a practitioner identifier associated with the practitioner; afacility identifier for an inpatient facility associated with thecarrier claim if the carrier claim occurred during a hospitalization atthe inpatient facility; or a most common facility associated with thepractitioner.
 12. The system of claim 11, wherein the instructions aresuch that identifying the carrier claim comprises identifying aplurality of carrier claims processed by the practitioner over a timeperiod, and wherein the method further comprises identifying a pluralityof facility claims processed by the facility over the time period. 13.The system of claim 12, wherein the instructions are such that matchingthe carrier claim to the facility comprises matching at least one of theplurality of carrier claims to at least one of the plurality of facilityclaims based on the claims factor to generate one or more matchedclaims.
 14. The system of claim 13, wherein the instructions furthercomprise: calculating a percentage of outpatient claims based on apercentage of office claims performed by the practitioner that did notoccur at the facility by collapsing the one or more matched claims on apractitioner identifier associated with the practitioner; andcalculating a level of confidence the practitioner is employed by thefacility based on the one or more matched claims and the percentage ofoutpatient claims.
 15. The system of claim 14, wherein the instructionsfurther comprise: collapsing the one or more matched claims to a grouplevel, wherein the facility is a healthcare facility associated with ahealthcare group; and calculating a percentage of employment bycalculating a percentage of practitioners associated with the healthcaregroup that are employed by a facility associated with the healthcaregroup.
 16. The system of claim 11, wherein the instructions are suchthat matching the carrier claim to the facility comprises matching basedon: in a first matching iteration, a patient identifier for a patientthat received a procedure from the practitioner, a date of service forthe procedure performed, and a procedure code for the procedure; in asecond matching iteration, the patient identifier, the date of service,and an practitioner ID (National Provider Identifier) associated withthe practitioner; in a third matching iteration, an inpatient facilityassociated with a carrier claim if the carrier claim occurred during ahospitalization at the inpatient facility; in a fourth matchingiteration, the date of service and a most common facility associatedwith the practitioner; and in a fifth matching iteration, the mostcommon facility associated with the practitioner as determined based onan clinic ID (National Provider Identifier) in a carrier claim.
 17. Thesystem of claim 16, wherein the instructions are such that matching thecarrier claim to the facility comprises matching based on: in a sixthmatching iteration, the date of service and the most common facilityassociated with the practitioner; in a seventh matching iteration, thedate of service and recent most common facility associated with thepractitioner based on claims processed by the practitioner in a recenttime period; in an eighth matching iteration, the date of service andthe most common facility associated with the practitioner; in a ninthmatching iteration, a most common facility associated with thepractitioner using previously joined facilities; and in a tenth matchingiteration, a facility most closely link to the clinic ID based on thecarrier claim.
 18. The system of claim 17, wherein the instructions aresuch that matching the carrier claim to the facility comprises matchinga plurality of carrier claims billed by the practitioner over a timeperiod to one or more facilities.
 19. The system of claim 18, whereinthe instructions are such that: matching the plurality of carrier claimsto the one or more facilities comprises performing a plurality ofindependent matching iterations in succession, wherein the plurality ofindependent matching iterations comprises the first matching iteration,the second matching iteration, the third matching iteration, the fourthmatching iteration, the fifth matching iteration, the sixth matchingiteration, the seventh matching iteration, the eight matching iteration,the ninth matching iteration, and the tenth matching iteration; and foreach matching iteration of the plurality of independent matchingiterations, matching previously unmatched carrier claims of theplurality of carrier claims to a facility of the one or more facilitiesbased on one or more claims factors in an instant matching iteration.20. The system of claim 11, wherein the claims factor comprises each of:the patient identifier, wherein the patient identifier is associatedwith a patient that received a procedure from the practitioner; the dateof service for the procedure billed on the carrier claim; a procedurecode for the procedure billed on the carrier claim; the practitioneridentifier associated with the practitioner, wherein the practitioneridentifier is an individual National Provider Identifier; the facilityidentifier for the inpatient facility if the procedure billed on thecarrier claim occurred during a hospitalization at the inpatientfacility, wherein the facility identifier is a CMS Certification Number;the most common facility associated with the practitioner based on aplurality of carrier claims billed by the practitioner; a clinicidentifier associated with the facility, wherein the clinic identifieris an organization National Provider Identifier; and a facility mostcommonly linked to the clinic identifier based on the plurality ofcarrier claims billed by the practitioner.
 21. Non-transitory computerreadable storage media storing instructions for execution by one or moreprocessors, the instructions comprising: identifying a carrier claimprocessed by a practitioner; and matching the carrier claim to afacility to generate a matched claim based on a claims factor; whereinthe claims factor comprises one or more of: a patient identifier; a dateof service for a procedure billed on the carrier claim; a practitioneridentifier associated with the practitioner; a facility identifier foran inpatient facility associated with the carrier claim if the carrierclaim occurred during a hospitalization at the inpatient facility; or amost common facility associated with the practitioner.
 22. Thenon-transitory computer readable storage media of claim 21, wherein theinstructions are such that identifying the carrier claim comprisesidentifying a plurality of carrier claims processed by the practitionerover a time period, and wherein the method further comprises identifyinga plurality of facility claims processed by the facility over the timeperiod.
 23. The non-transitory computer readable storage media of claim22, wherein the instructions are such that matching the carrier claim tothe facility comprises matching at least one of the plurality of carrierclaims to at least one of the plurality of facility claims based on theclaims factor to generate one or more matched claims.
 24. Thenon-transitory computer readable storage media of claim 23, wherein theinstructions further comprise: calculating a percentage of outpatientclaims based on a percentage of office claims performed by thepractitioner that did not occur at the facility by collapsing the one ormore matched claims on a practitioner identifier associated with thepractitioner; and calculating a level of confidence the practitioner isemployed by the facility based on the one or more matched claims and thepercentage of outpatient claims.
 25. The non-transitory computerreadable storage media of claim 24, wherein the instructions furthercomprise: collapsing the one or more matched claims to a group level,wherein the facility is a healthcare facility associated with ahealthcare group; and calculating a percentage of employment bycalculating a percentage of practitioners associated with the healthcaregroup that are employed by a facility associated with the healthcaregroup.
 26. The non-transitory computer readable storage media of claim21, wherein the instructions are such that matching the carrier claim tothe facility comprises matching based on: in a first matching iteration,a patient identifier for a patient that received a procedure from thepractitioner, a date of service for the procedure performed, and aprocedure code for the procedure; in a second matching iteration, thepatient identifier, the date of service, and an practitioner ID(National Provider Identifier) associated with the practitioner; in athird matching iteration, an inpatient facility associated with acarrier claim if the carrier claim occurred during a hospitalization atthe inpatient facility; in a fourth matching iteration, the date ofservice and a most common facility associated with the practitioner; andin a fifth matching iteration, the most common facility associated withthe practitioner as determined based on an clinic ID (National ProviderIdentifier) in a carrier claim.
 27. The non-transitory computer readablestorage media of claim 26, wherein the instructions are such thatmatching the carrier claim to the facility comprises matching based on:in a sixth matching iteration, the date of service and the most commonfacility associated with the practitioner; in a seventh matchingiteration, the date of service and recent most common facilityassociated with the practitioner based on claims processed by thepractitioner in a recent time period; in an eighth matching iteration,the date of service and the most common facility associated with thepractitioner; in a ninth matching iteration, a most common facilityassociated with the practitioner using previously joined facilities; andin a tenth matching iteration, a facility most closely link to theclinic ID based on the carrier claim.
 28. The non-transitory computerreadable storage media of claim 27, wherein the instructions are suchthat matching the carrier claim to the facility comprises matching aplurality of carrier claims billed by the practitioner over a timeperiod to one or more facilities.
 29. The non-transitory computerreadable storage media of claim 28, wherein the instructions are suchthat: matching the plurality of carrier claims to the one or morefacilities comprises performing a plurality of independent matchingiterations in succession, wherein the plurality of independent matchingiterations comprises the first matching iteration, the second matchingiteration, the third matching iteration, the fourth matching iteration,the fifth matching iteration, the sixth matching iteration, the seventhmatching iteration, the eight matching iteration, the ninth matchingiteration, and the tenth matching iteration; and for each matchingiteration of the plurality of independent matching iterations, matchingpreviously unmatched carrier claims of the plurality of carrier claimsto a facility of the one or more facilities based on one or more claimsfactors in an instant matching iteration.
 30. The non-transitorycomputer readable storage media of claim 21, wherein the claims factorcomprises each of: the patient identifier, wherein the patientidentifier is associated with a patient that received a procedure fromthe practitioner; the date of service for the procedure billed on thecarrier claim; a procedure code for the procedure billed on the carrierclaim; the practitioner identifier associated with the practitioner,wherein the practitioner identifier is an individual National ProviderIdentifier; the facility identifier for the inpatient facility if theprocedure billed on the carrier claim occurred during a hospitalizationat the inpatient facility, wherein the facility identifier is a CMSCertification Number; the most common facility associated with thepractitioner based on a plurality of carrier claims billed by thepractitioner; a clinic identifier associated with the facility, whereinthe clinic identifier is an organization National Provider Identifier;and a facility most commonly linked to the clinic identifier based onthe plurality of carrier claims billed by the practitioner.